连续性血液净化联合去甲肾上腺素在脓毒症休克患者早期治疗中的应用

Application of continuous blood purification combined with norepinephrine in early treatment of septic shock patients

目的 探讨连续性血液净化联合去甲肾上腺素在脓毒症休克患者早期治疗中的应用效果。方法 选择2018年10月~2020年10我院重症医学科脓毒症休克患者80例,按照入院顺序入组,随机分为对照组和观察组,每组40例。对照组患者给予常规治疗,观察组患者在给予常规治疗的同时,早期给予连续性血液净化联合去甲肾上腺素干预治疗。检测比较两组患者的临床疗效,比较两组患者治疗24h、48h及72h前后肿瘤坏死因子α(TNF-α)、白介素6(IL-6)、动脉血乳酸(LAC)、降钙素原(PCT)及超敏C反应蛋白(hs-CRP)水平,评价氧合指数(PO2/FiO2)、qSOFA评分以及APACHEⅡ评分等指标的变化,计算两组患者治疗28d死亡率。结果 观察组患者的治疗总有效率(92.50%)显著高于对照组(85.00%),差异有统计学意义(P<0.05);治疗前,两组患者的IL-6、PCT、TNF-α、LAC及hs-CRP水平比较,差异无统计学意义(P>0.05);治疗72h后,两组患者的IL-6、PCT、TNF-α、LAC及hs-CRP水平均明显下降,其中观察组患者水平下降更明显,与对照组比较,差异有统计学意义(P<0.05),PO2/FiO2高于对照组患者(P<0.05);治疗前,两组患者的qSOFA评分以及APACHEⅡ评分比较,差异无统计学意义(P>0.05);治疗72h后,两组患者的qSOFA评分以及APACHEⅡ评分较治疗前均下降明显,与对照组相比较,观察组评分下降更明显,差异有统计学意义(P<0.05);治疗28d,观察组死亡率为3.2%,对照组为7.1%,两组差异有统计学意义(P<0.05)。结论 早期采用连续性血液净化联合去甲肾上腺素治疗脓毒症休克患者,能有效降低血清炎症因子水平,改善血流动力学指标,可提高生存率,改善预后,值得推广。

Objective To investigate the effect of continuous blood purification combined with norepinephrine in the early treatment of septic shock.Methods From October 2018 to October 2020,80 patients with septic shock in our hospital were selected and randomly divided into control group and observation group, with 40 cases in each group.The control group was given routine treatment, while the observation group was given routine treatment and early continuous blood purification combined with norepinephrine intervention.The clinical efficacy, levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),arterial blood lactic acid(LAC),procalcitonin(PCT)and high-sensitivity C-reactive protein(hs-CRP),oxygenation index(PO2/FiO2) and SOFA were compared before and after 24,48 and 72 hours of treatment.The 28 day mortality rate of the two groups was calculated.Results The total effective rate of the observation group(92.50%) was significantly higher than that of the control group(85.00%),which was statistically significant(P<0.05).Before treatment, There was no significant difference in the levels of TNF-α,IL-6,LAC,PCT and hs-CRP between the two groups(P>0.05).After 72 hours of treatment, the levels of LAC,TNF-α,IL-6,PCT and hs-CRP in the two groups were significantly decreased, and the levels of TNF-α,IL-6,LAC,PCT and hs-CRP in the observation group were more significantly decreased than those in the control group(P<0.05),while PO2/FiO2was higher than that in the control group;Before treatment, there was no significant difference in SOFA score and APACHE Ⅱ score between the two groups(P>0.05).After 72 hours of treatment, there was no significant difference in SOFA score between the two groups.Compared with the control group, the score of the observation group decreased more significantly, which was statistically significant(P<0.05).After 28 days of treatment, the mortality of the observation group was 3.2%,and that of the control group was 7.1%.The difference was statistically significant(P<0.05).Conclusion Early use of continuous blood purification combined with norepinephrine in the treatment of septic shock patients can effectively reduce the level of serum inflammatory factors, improve hemodynamic indexes, improve the survival rate and prognosis, which is worthy of promotion.